Dysfunctional coping in headache: Avoidance and endurance is not associated with chronic forms of headache

T. Wieser, U. Walliser, I. Womastek & H.G. Kress

Abstract
Introduction: About 4% of the population suffer from daily or near
daily headache, which in most cases evolved from an episodic type of
headache. The impact of psychological factors on this process is unknown.
It seems reasonable to assume, that besides somatic and social conditions
psychological factors like pain-related coping and cognition play an
important role, as has been shown for other pain conditions.
Methods: We performed a cross sectional study on pain coping behaviour
in 211 patients with migraine and tension type headache. Pain-related
cognition and coping was investigated using the Kiel Pain Inventory.
Prevalence of depression, medication intake and headache characteristics
were analysed in regard to chronicity of headache.
Results: Overall pain intensity was high in the patient sample. The level
of depression increased with headache frequency. Dysfunctional coping,
characterized by fear and avoidance is frequently used by headache
patients. As in low back pain, also endurance is highly prevalent. Other
features known to be associated with chronic headache, like depression
and medication overuse, could be confirmed.
Discussion: Dysfunctional coping was seen with high prevalence in the
entire patient sample (66%). Against our hypothesis, it was not confined
to chronic forms of headache. In respect to our data, we discuss the role
of avoidance and endurance coping in headache and its possible role in
chronicity.